Housing options for people with mental health issues vary greatly

Jun. 16, 2013

Angie Gormely, of Newark, works on a drawing in pastels during art group time at The Main Place, a community-based, consumer-operated mental health recovery center. Gormely looks forward to the weekly art group, saying it is relaxing and cheers her up when she's feeling depressed. / Photos by Sara C. Tobias/CentralOhio.com

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CentralOhio.com

Larry Racette, who provides peer support at The Main Place, shows plans for The Place Next Door, which will provide housing next door to the community-based mental health recovery service center.

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For years in Richmond, Va., and then Newark, Ohio, Larry Racette spent his Supplemental Security Income check on booze and drugs to mask his schizoid personality disorder, dissociative fugue, depression and obsessive-compulsive disorder. He lived on the streets, in jail and in a hospital for 105 days with two tubes in his neck.

It wasn’t until he attended sessions at The Main Place, a Newark mental health recovery center operated by individuals who have mental illness, for the free coffee and food that he realized life could be easier.

The Main Place and its partners helped Racette into an apartment near the local library, and he now works as a peer support for others. The Main Place, and community-based settings like it, help people in ways nursing homes and psychiatric hospitals cannot, Racette said.

“They are being maintained, but do they have a quality of life? No,” he said.

Ohio has devoted millions of state and federal dollars to transition people with severe and persistent mental illness into apartments and group homes to save money and improve the individual’s quality of life.

On Wednesday, Gov. John Kasich’s office announced Ohio will receive more than $169 million in Medicaid dollars to shift 50 percent of longterm care expenditures for elders and people with disabilities to home and community-based services — such as apartments, homes and group homes — by September 2015.

But the quality and quantity of living spaces varies dramatically from place to place. Richland County has dozens of group homes established for decades, while adjacent Crawford County has no place to move people and little caseworker time to divert from the growing opiate epidemic.

On average, Ohio Medicaid spends $102,500 each year on a physically healthy person diagnosed with severe and persistent mental illness who is living in a nursing home. Moving that person into an apartment, relative’s home or group home saves about $35,250 each year, according to the Ohio Department of Mental Health.

Individuals with severe and persistent mental illness who live outside an institution are healthier, more likely to be employed and less likely to commit crimes, said Glenn Hopkins, executive director of The Main Place.

“We live and practice that people are capable of recovering in the least-restricting environment,” Hopkins said.

Leaving nursing homes

In January 2007, Ohio was one of 17 states awarded a Money Follows the Person Demonstration Grant to relocate seniors and individuals with disabilities from nursing homes to their own spaces. Several Ohio departments created Helping Ohioans Move, Expanding Choice with the more-than $100,000 Medicaid grant.

Since HOME Choice’s implementation in 2008, more than 3,200 Ohioans have moved into homes and apartments where they can care for themselves, sometimes with minimal assistance of others.

Use of the program to assist individuals diagnosed with mental illness has improved throughout the years. Between 2008 and 2011, about 40 people were transferred into community-based setting through HOME Choice. To date, 977 people who met the mental health qualifications have left nursing homes, including 208 individuals this year so far.

In Fairfield County, 10 people have moved out of nursing homes through the program.

Before that program, it was nearly impossible for individuals receiving $30 per month from Supplemental Security Income to save up enough money for a downpayment on an apartment, said Becky Stamm, program manager for Access Home Choice, a HOME Choice provider.

“A lot of people just see this as their last chance to get out. A lot of people don’t need to be in the nursing home,” Stamm said.

HOME Choice provides up to $2,000 to individuals with mental illness, developmental disabilities or physical disabilities who want to move out of nursing homes and are capable of doing so. Applicants must have lived in a nursing home for at least 90 days and be eligible for Medicaid.

The money can pay for a deposit, a bed, linens, groceries and other necessities. One client used the money to remove a tree that blocked his wheelchair ramp and prevented him from entering his home, Stamm said.

“They get a sense of pride because we’re giving them something that’s theirs,” said Stamm, adding that many people she helps never thought they could leave the nursing home.

Individuals are monitored for 365 non-consecutive days and taught life skills, such as paying bills before luxuries like cigarettes, Stamm said. If a person is briefly hospitalized, those days typically do not count toward the 365-day total, she said.

One woman used those 365 days to start a Bible study in her apartment complex, make coffee for other residents and create a cookie exchange, Stamm said. She never would have had those opportunities in an institution.

“She’s just flourishing now,” Stamm said.

Weighing safety and cost

Another area where Ohio officials are trying to cut costs is eliminating the number of people with extended stays at Ohio’s six regional psychiatric hospitals. Between fiscal years 2011 and 2012, enrollment in these facilities increased 18 percent, which was too high for Ohio Department of Mental Health Director Tracy Plouck.

Sixty-five percent of the individuals sent to state psychiatric hospitals are forensic patients — individuals facing criminal charges who are found not competent to stand trial or found not guilty by reason of insanity.

Whether forensic patients can leave their rooms, visit home or leave the facility all depends on approval from judges presiding over their cases, said Dr. Mark Hurst, medical director with the Ohio Department of Mental Health. These checks and balances, intended to keep the public safe, often lengthen patients’ time at the facility and add to the cost, he said.

State hospital enrollment increased between 3 and 6 percent between fiscal years 2012 and 2013, a marked improvement mostly because of improved communication with local mental health boards that coordinate housing, Plouck said.

But not every county has a halfway home where those released from the state psychiatric hospital can stay. The closest facility for Fairfield County residents is in Athens County, the same county as the state hospital, so residents aren’t moving much closer to home, said Rhonda Myers, executive director of the Fairfield County Alcohol, Drug and Mental Health Board.

“There are not a lot of housing resources. People need subsidized housing. That’s a huge problem,” Myers said. HOME Choice funds cannot be used for these individuals.

In Licking and Knox counties, where transitional housing is more available, the board surpassed its goal of keeping state hospital stays low, said Kay Spergel, executive director of Mental Health & Recovery for Licking and Knox Counties.

Quality and quantity of housing limited

Finding affordable, safe housing is the biggest challenge to these programs’ success. Because living space expenses are not covered under Medicaid, advocates must find other ways to pay rent, said Cheri Walter, chief executive officer of the Ohio Association of County Behavioral Health Authorities.

There are no group homes in Crawford County, and Marion County has one adult-care facility. Sometimes people are sent to Seneca, Richland and Ashland counties for care, said Jody Demo-Hodgins, executive director of the Crawford-Marion Board of Alcohol, Drug Addiction and Mental Health Services.

“We are drowning. Resources are at the lowest point that we’ve ever seen,” she said.

Stamm, who is tasked with finding housing for individuals, said there are not enough low-income or income-based apartments across Ohio and not enough U.S. Department of Housing and Urban Development vouchers to go around. Individuals typically have $710 in Supplemental Security Income to pay for rent, bills, groceries and other living expenses, Stamm said.

“With $710 a month, you would be flabbergasted at how unbelievably difficult it is to house these people,” Stamm said.

Even with an adequate number of group homes — Ross County had the 11th most in the state — finding the right fit for an individual can be difficult if one facility only takes middle-aged men or another subgroup, said Johnson Frey, director of the ADAMH board.

But housing isn’t a challenge everywhere. Richland County Alcohol, Drug Addiction and Mental Health Board and a local non-profit organization, Catalyst Life Services, operate about 80 units throughout the county that house individuals with severe and persistent mental illness, said Joe Trolian, executive director of the board.

In the 1960s, Richland County officials realized housing individuals in the least restrictive environments helped to lower service costs and improve mental health, Trolian said.

Initiatives on the way

Plouck hopes programs in the state budget will cut down on housing disparity, which she acknowledges is widespread across Ohio.

Kasich’s budget would authorize some of the Medicaid money saved from moving an individual out of nursing homes to individuals to help them find appropriate housing. His goal was to help 1,200 nursing home residents younger than 60 transition over two years, Plouck said.

Kasich projected the program, called Recovery Requires a Community, would save $43.9 million, including $16 million in state dollars, over the two years. The provisions remain in the state budget, which will be debated in conference committee starting Tuesday, and Plouck is confident legislators will approve the measures.

Last year’s capital budget invested $10 million in housing for mental health. The Main Place in Newark was one organization that received money from that appropriation, which it will use to build a 10-unit location called the Place Next Door.

The housing could help people such as a man Hopkins is visiting in the state hospital. He has not left the hospital for 10 years and is baffled by technology such as ATMs and security tags on clothes.

“You wouldn’t believe his reaction to these,” Hopkins said. But it’s to be expected of an individual who has spend a decade institutionalized. “That’s how different the world is.”

Plouck said money won’t solve all the county’s housing shortages, but it’s still the largest investment in housing for individuals with mental health issues in about a decade.

“I think with any system like this, the resource allocation, the money allocation is always a challenge,” said Sally Luken, director of Ohio’s Corporation for Supportive Housing. But she’s optimistic that recent efforts will make a difference. “We have some really great leadership at the state level, prioritizing money for the disabled.”